How Much Does Upper Endoscopy (EGD) with Biopsy Cost?
Also known as: Egd biopsy single/multiple (CPT 43239)
An upper endoscopy with biopsy, where tissue samples are taken from the esophagus, stomach, or duodenum.
The total estimated cost of Upper Endoscopy (EGD) with Biopsy (CPT 43239) is $415 to $779, including hospital fees, anesthesia, and supplies. The surgeon's Medicare fee alone is $124.
Total Estimated Cost of Care
This estimate includes hospital facility fees, anesthesia, and supplies .
Patient Guide: Upper Endoscopy (EGD) with Biopsy
What you need to know before your appointment
What to Expect
During the upper endoscopy, the doctor takes small tissue samples using a tiny tool through the scope. You will not feel the biopsies. Samples are sent to a lab for analysis.
How Long Does It Take?
15-30 minutes (plus recovery)
Common Reasons Doctors Order This
Evaluation of esophagitis, celiac disease diagnosis, H. pylori testing, Barrett esophagus monitoring, stomach inflammation
How to Prepare
Same as standard upper endoscopy. Inform your doctor about blood thinners.
Procedures Commonly Done Together
These procedures are frequently performed alongside Egd biopsy single/multiple
What Insurance Companies Actually Pay
Real negotiated rates from 15 hospitals across 6 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $2,547 | $567 - $6,158 | 9 |
| United | $2,262 | $359 - $5,268 | 10 |
| Cigna | $2,577 | $880 - $7,221 | 9 |
| Humana | $2,194 | $419 - $4,690 | 8 |
| BCBS | $1,429 | $352 - $2,146 | 5 |
| Superior Health Plan | $977 | $948 - $1,409 | 4 |
| KAISER FOUNDATION HEALTH PLAN, INC. | $1,957 | $1,133 - $3,547 | 5 |
| BCBS-TX | $1,090 | $589 - $1,509 | 2 |
| Multiplan | $3,209 | $1,454 - $11,500 | 6 |
| Wellpoint | $674 | $335 - $1,409 | 2 |
| Molina Healthcare | $368 | $368 | 2 |
| Community Health Choice MCD | $375 | $375 | 2 |
How to Reduce Your Cost for Egd biopsy single/multiple
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($419) differs from the facility rate ($124). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (12.54) x CF ($33.40) = $419
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Egd biopsy single/multiple cost?
The Medicare facility rate for Egd biopsy single/multiple is $124. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Egd biopsy single/multiple cost without insurance?
Without insurance, the cost of Egd biopsy single/multiple can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Egd biopsy single/multiple?
Most commercial health insurance plans and Medicare cover Egd biopsy single/multiple when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.